Credentialing Operations Specialist

2 weeks ago


Miami, United States Care People Solutions Full time

Overview:

The role of a Credentialing Operations Specialist involves overseeing the systematic process through which healthcare professionals are granted the necessary licenses and certifications within an organization. This position is crucial in ensuring that all credentials, licenses, and certifications are accurate, current, and compliant with both regulatory and organizational standards. You will collaborate closely with healthcare providers to verify their qualifications and facilitate their integration into the organization, thereby ensuring efficient operational workflows.

Key Responsibilities:

  1. Management of Credentialing Processes: Oversee the entire credentialing process for both new and existing healthcare providers, ensuring adherence to organizational and regulatory timelines.
  2. Qualification Verification: Conduct thorough verification of educational backgrounds, training, licenses, board certifications, and work history relevant to the medical profession.
  3. Document Oversight: Maintain and update all licensing documents, including licenses and certifications, within a centralized database.
  4. Compliance Oversight: Monitor compliance with professional standards established by regulatory bodies and internal policies.
  5. Coordination and Communication: Serve as the primary contact for healthcare providers, collaborating with HR, legal, and clinical teams to gather necessary information and documentation.
  6. Audit Readiness: Assist in preparing for audits conducted by regulatory agencies or accreditation bodies by providing required documentation and ensuring records are up-to-date.
  7. Renewal Oversight: Track credential expiration dates and manage the renewal process proactively to maintain compliance.
  8. Issue Resolution: Address any discrepancies or issues related to provider credentialing in partnership with relevant departments.
  9. Reporting: Generate quarterly reports detailing credentialing status and compliance metrics, including the duration of application processing.
  10. Process Enhancement: Identify opportunities for improving efficiency in the credentialing process, including streamlining workflows and enhancing accuracy through best practices.

Qualifications:

  • Bachelor's degree or equivalent qualification in healthcare administration or business administration; relevant experience will also be considered.
  • Prior experience in a credentialing organization, compliance department, or healthcare administration is preferred.
  • Exceptional attention to detail and strong organizational skills.
  • Excellent communication and interpersonal abilities.
  • Capability to work independently while managing multiple priorities.
  • Familiarity with credentialing software and databases is advantageous.
  • Understanding of healthcare regulations, accreditation standards, and compliance requirements is essential.

Work Environment:

  • Full-time remote position.
  • Collaborative team atmosphere with opportunities for professional development.
  • Competitive salary structure.


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